Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders

Kahn, Henry S.; Bullard, Kai McKeever

doi:10.1016/j.amjmed.2015.08.010

Cited by 31 publications

(27 citation statements)

References 47 publications

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“…While neither of these studies used the gold standard to measure glucose metabolism, OGTT, they corroborated the present results using HbA1c values [42, 46]. …”

Section: Discussionsupporting

confidence: 86%

“…Only two previous studies have been conducted on a large national sample of US adults to investigate the relationship between SAD and glucose metabolic disturbances [42, 46]. While neither of these studies used the gold standard to measure glucose metabolism, OGTT, they corroborated the present results using HbA1c values [42, 46].…”

Section: Discussionsupporting

confidence: 78%

“…Taking a SAD measurement requires only an examination table and portable caliper, and a patient can simply expose the midabdominal area, without having to change clothes or remove outer layers, shoes, jewelry, or medical appliances [46]. These accommodations allow individuals significant comfort and modesty, while still providing useful information to a healthcare provider.…”

Section: Discussionmentioning

confidence: 99%

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Sagittal Abdominal Diameter, Waist Circumference, and BMI as Predictors of Multiple Measures of Glucose Metabolism: An NHANES Investigation of US Adults

Firouzi

Tucker

LeCheminant

et al. 2018

Journal of Diabetes Research

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The objective was to compare associations between sagittal abdominal diameter (SAD), waist circumference, and BMI to the oral glucose tolerance test (OGTT), along with fasting glucose, HbA1c, and HOMA-IR, in a nationally representative sample of 3582 US adults. The study also analyzed the effect of multiple covariates on the anthropometric and glucose metabolism associations. A cross-sectional design was used. SAD was assessed using an abdominal caliper. All other data were collected following strict NHANES protocols. The OGTT was the primary variable used to index glucose metabolism. Fasting glucose, HbA1c, and HOMA-IR were also evaluated. Results showed that mean ± SE values were as follows: SAD: 22.3 ± 0.1 cm, waist circumference: 98.0 ± 0.4 cm, BMI: 28.6 ± 0.2 kg/m2, OGTT: 113.9 ± 1.0 mg/dL, fasting glucose: 99.6 ± 0.3 mg/dL, HbA1c: 5.4 ± 0.01%, and HOMA-IR: 3.2 ± 0.1. Compared to waist circumference and BMI, SAD consistently emerged as the best predictor of glucose metabolism, before and after adjusting for the covariates, and with the sample stratified by gender, race, or age. SAD was not a better predictor of OGTT among normal-weight adults or non-Hispanic Black adults. Due to the ease of taking SAD measurements, we recommend that healthcare providers use this simple method to more precisely predict diabetes risk, especially among overweight and obese adults.

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“…While neither of these studies used the gold standard to measure glucose metabolism, OGTT, they corroborated the present results using HbA1c values [42, 46]. …”

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sagittal Abdominal Diameter, Waist Circumference, and BMI as Predictors of Multiple Measures of Glucose Metabolism: An NHANES Investigation of US Adults

Firouzi

Tucker

LeCheminant

et al. 2018

Journal of Diabetes Research

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“…Earlier cross-sectional studies have demonstrated that WHtR [12,13,21] or SADHtR [21] were similarly associated with traditional risk factors for cardiometabolic disease, and that these associations were generally stronger than those with BMI.…”

Section: Discussionmentioning

confidence: 99%

“…Since the supine sagittal abdominal diameter (SAD, also called “abdominal height”) correlates strongly with the amount of visceral fat [15,16] and with traditional cardiometabolic risk markers [17–19], several authors have extended consideration to the SAD/height ratio (SADHtR) as yet one more alternative to the BMI [10,11,20,21]. Beginning in 2011, the supine SAD has been measured routinely in the U.S. National Health and Nutrition Examination Survey (NHANES) along with waist circumference, height, and weight.…”

Section: Introductionmentioning

confidence: 99%

Comparison of adiposity indicators associated with fasting-state insulinemia, triglyceridemia, and related risk biomarkers in a nationally representative, adult population

Kahn

Cheng

2018

Diabetes Research and Clinical Practice

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Aims We hypothesized that height-corrected abdominal size (supine sagittal abdominal diameter/height ratio [SADHtR] or waist circumference/height ratio [WHtR]) would associate more strongly than body mass index (BMI, weight/height2) with levels of fasting insulin, triglycerides, and three derived biomarkers of insulin resistance. Methods Anthropometry, including SAD by caliper, was collected on 4398 adults in the 2011–2014 National Health and Nutrition Examination Survey. For comparison purposes, each adiposity indicator was scaled to its population-based, sex-specific, interquartile range (IQR). For each biomarker we created four outcome groups based on equalsized populations with ascending values. Multivariable polytomous logistic regression modeled the relationships between the adiposity indicators and each biomarker. Results Highest-group insulin was associated with a one-IQR increment of BMI (RR 4.3 [95% CI 3.9–4.9]), but more strongly with a one-IQR increment of SADHtR (RR 5.7 [5.0–6.6]). For highest-group HOMA-IR the RR for BMI (4.2 [3.7–4.6]) was less than that of SADHtR (6.0 [5.1–7.0]). Similarly, RRs for BMI were smaller than those for SADHtR applying to highest-group triglycerides (RR 1.6 vs 2.1), triglycerides/HDL-cholesterol (RR 1.9 vs 2.4) and TyG index (RR 1.7 vs 2.2) (all p < .001). The RRs for WHtR were consistently between those for SADHtR and BMI. The top 25% of insulin resistance among US adults was estimated to lie above adiposity thresholds of 0.140 for SADHtR, 0.606 for WHtR, or 29.6 kg/m2 for BMI. Conclusions Relative abdominal size rather than relative weight may better define adiposity associated with homeostatic insulin resistance. These population-based, cross-sectional findings could improve anthropometric prediction of cardiometabolic risk.

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Relationships between measures of adiposity with subclinical atherosclerosis in patients with type 2 diabetes

Yuan

Hsu

Bowden

et al. 2016

Obesity

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Objective: Assess cross-sectional relationships between body mass index (BMI), waist circumference (WC), pericardial (PAT), visceral (VAT), and subcutaneous adipose tissue (SAT) volumes with calcified plaque (CP) in African Americans (AAs) and European Americans (EAs) with type 2 diabetes. Methods: Computed tomography measured PAT, VAT, SAT, and CP in coronary arteries (CAC), carotid arteries, and aorta. Generalized estimating equations models were fitted to test for associations between adiposity and CP, stratified by ethnicity while accounting for familial correlations. Results: AAs (N 5 753) vs. EAs (N 5 562) had significantly lower PAT and VAT, despite equal or higher BMI. In multivariable models adjusting for age, gender, education, HbA1c, statins, smoking, cardiovascular disease, hypertension, nephropathy, and C-reactive protein, PAT positively associated with presence of CAC in AAs (P < 0.001), not EAs (P 5 0.68; ethnicity interaction P < 0.01). Inverse associations were detected between SAT and severity of aorta CP (P < 0.01) in AAs and between BMI, WC, and SAT with severity of aorta CP in all participants. Conclusions: Ethnic-and gender-specific differences in BMI, WC, PAT, SAT, and VAT were present in AAs and EAs with diabetes. Only PAT was positively associated with CAC in AAs; paradoxical inverse associations were seen between several other adiposity measures and subclinical cardiovascular disease.

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Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders

Cited by 31 publications

References 47 publications

Sagittal Abdominal Diameter, Waist Circumference, and BMI as Predictors of Multiple Measures of Glucose Metabolism: An NHANES Investigation of US Adults

Sagittal Abdominal Diameter, Waist Circumference, and BMI as Predictors of Multiple Measures of Glucose Metabolism: An NHANES Investigation of US Adults

Comparison of adiposity indicators associated with fasting-state insulinemia, triglyceridemia, and related risk biomarkers in a nationally representative, adult population

Relationships between measures of adiposity with subclinical atherosclerosis in patients with type 2 diabetes

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